Making high quality mental healthcare accessible for everyone

Episode 1 – Telehealth: Making Mental Health More Accessible

Steve: Welcome one and all to the first ever talking shop podcast, a series of interviews and conversations focusing on psychology from a range of angles which is produced by The Talk Shop. My name is Steve Sweeney, and I am delighted to help bring this series to life with the assistance of the psychological team from The Talk Shop and other notable contributors whom we’ll meet along the way. We want this series to further lift the veil on mental health issues across Melbourne, Victoria, and the country. I say further because since COVID, mental health has become a topic which many more people are now comfortable talking about, and that is a great thing. However, it doesn’t mean that the stigma, the confusion, the feelings of low self-worth, and other emotional side effects have disappeared. We may never achieve that, but we’re certainly giving it a try. One of the elements of our mission at The Talk Shop is to make quality mental healthcare accessible to all, and there’s no better way to reduce the barriers than to conduct therapy sessions online. And here to discuss this in some detail with me is my first ever guest, Rhonda Lowe. Rhonda is a telehealth practitioner here at The Talk Shop. She lives in New South Wales and teleports her way in a few times per week to work her magic with her clients virtually. Rhonda Lowe, welcome to the show.

Rhonda: Thanks Steve. 

Steve: I wanted to begin, please, Rhonda, by telling us a little bit about being a psychologist.

Rhonda: Being a psychologist is a great profession. There is never a dull moment. There are never two days that are alike. It’s very rewarding when you see the progress that clients make and they recognise the progress as well. And you see them for a first session and they’re very upset. And the second session, when you see that their demeanour is totally different, it’s very, very rewarding. And it’s very broad. When you study psychology, you can get into a broad range of industries as well. So as far as never being bored in a job, this is definitely one of those jobs.

Steve: I’m certain it is. And as you know, Rhonda, I work with all of the psychologists here at The Talk Shop, and none of them complain about boredom. 

Rhonda: Exactly.

Steve: It is obviously something that draws extraordinarily caring people to it in terms of a profession. And you’re right. With psychology, you can go in all sorts of different places in terms of a career. And I know, for example, that you were involved in marketing. They’re kind of related, aren’t they? Psychology.

Rhonda: Yeah, that’s right. Yes, I think they are definitely related. It’s based on understanding human behaviour. I think with marketing, though, I guess the big difference between marketing and being a practising psychologist is with a psychologist, you want to give something to the client, whereas marketing you want something from the client. You want to motivate the client. You want to study your clients. You know how to access the clients that you’re targeting. So it’s still a study of human behaviour, I guess. So yeah, they’re very similar in that way.

Steve: Yes, they are. And you’re right about the motivation and inspiration and all of those other almost soft, happy, endings, I suppose, that you your clients to experience. So what interested you about psychology enough to make you want to turn it into a career? There’s a thousand other things that you now, a human being could do.

Rhonda: Yeah, exactly. Well, I actually came into psychology quite late. In my early career, I always did something where I worked with clients. So I was used to that. And I was always interested in human behaviour. And it wasn’t until I got as I got closer and closer, and then there was the study of marketing, and there was the study of psychology that was involved in marketing, that I realised that this was the only industry that I really wanted to work in. It was the right fit. And so that’s how I moved into psychology, basically.

Steve: Into practising psychology as a profession. Yes. And so there’s even multiple arms to psychology. As I understand that there are nine different areas of endorsement. And so what made clinical psychology attractive to you?

Rhonda: I think it wasn’t… There were other areas that were also attractive to me, but I think because at the beginning of my career, I was always working with clients that I just stuck with working with clients. I was working with different demographics, though, so I’ve had a lot of experience working with different demographics. But I guess I’ve had the most experience working face to face with clients. While I was at university, I did have an interest in organisational psychology, so that you can work in HR, in that sort of thing and designing teams for companies and whatnot, which is really fascinating. And maybe other child development or developmental psychology was really fascinating as well. But this, I kind of had… My career just sort of went in this direction of working with clients. And so that’s how I ended up in this area, I guess.

Steve: And you’ve stayed with it, and you’re very successful at it. So win-win. Win for the clients that you’re able to see. So COVID hit us all pretty hard in the early 20s, and suddenly psychologists who are right up there in the caring professions, they couldn’t see their clients in person. Now, I understand you weren’t working with clients at the time, but nonetheless, can you shed some light on how that sudden change from person to person to telehealth affected some of your clients?

Rhonda: Yes, definitely. Not so much. I can’t tell you so much about how they affected my clients. Though I must admit, when COVID hit, I did often think about my old clients and think that I hope they’re okay dealing with this. I had one client who worked in the airline industry, actually, and I’m sure everybody understands how the airline industry was affected by COVID. And I was often wondering, I hope he’s okay. I wonder how he’s dealing with this because it means a lot of work. So I thought about my old clients and how it affected them. There were a lot of colleagues that I had who were still working in the industry when COVID hit. So I heard what they had to say about it. One of the main things was because the whole world was so unprepared for pandemic. And so when it hit. Everybody was just struggling to work out how do we deal with this. And I think that adjustment period was quite hard for every industry, including counselling. But I think what came out of that, which I think is a really great thing, is that people, you know telehealth was offered and people were able to adjust to a new way of getting counselling. And a way where they could still stay safe and be at home. And there are all these other benefits in telehealth as well. There are clients who have suffered from agoraphobia or social anxiety for those reasons, have a lot of trouble leaving their homes. And all of a sudden, psychology, getting counselling is now accessible to them. So that was a real benefit. So I think as people adjust with the things that COVID has made us adjust to, I think a lot of people have become more open minded about telehealth and understanding that it can be really beneficial for them. And maybe it might fit them better than normal face to face counselling.

Steve: I think you’re absolutely right, because it’s not a case in psychology of one size fits all. There are multiple different presentations, which we’ll go through some of them soon and tap into your expertise there. But some are more suitable for a telehealth than they are to face to face and vice versa. And so opening up that scope of people who can now access it is just wonderful, I think, because imagine… So we have one lady working for us who is in Central West New South Wales, and she is a telehealth practitioner, and she is the only psychologist around for 300 kilometres.

Rhonda: Yes.

Steve: And so now her clients don’t need to travel 300 kilometres. They can just zoom in and out of calls just like you and I are doing today.

Rhonda: Exactly. Before telehealth came into this boom for COVID, so obviously there are issues with confidentiality and people knowing there’s that unfortunate stigma of getting counselling in some areas. And so if you live in a small remote town and let’s say hypothetically, you break up with your partner and you want to seek counselling, you find the closest counsellor. It means that if your husband or your partner also needs counselling, they can’t go to the same counsellor. They have to travel however long they have to travel for to seek another counsellor because there’s that issue of confidentiality and also.. I’ve lost it at the moment but 

Steve: Potential conflicts?

Rhonda: Exactly, conflict of interest. And so, I think people in remote areas were really, you know they didn’t have access to all of the psychologist. There might have been one psychologist within a 100k so whatever. And also in small towns too, there are issues where you know, if you have a psychologist that’s a friend of yours, should you go and see them. And now you can see a psychologist anywhere around the world. So it really does open things up for clients and they can pick and choose rather than be hindered by where they live.

Steve: And that absolutely right. So I’m aware that we have one working for us who’s over in Austria.

Rhonda: Wow. 

Steve: She used to live in Australia and she went to live in Austria I believe she’s coming back at some stage but yes, from that point of view, it’s now an extraordinary portable profession, isn’t it? 

Rhonda: It is 

Steve: So once on telehealth, you and your colleagues were all suddenly receiving less data from your clients because the whole body wasn’t just visible. Like it is when you’re in face-to-face session. How did you personally handle that?
Rhonda: Well, I must admit, when I was transitioning from face-to-face counseling to telehealth counseling because I’ve had no experience in telehealth counseling. I did wonder and hoped I could develop a good working relationship with the client feels comfortable working with me as well when we’re face to face. So that was something I was quite worried about. However, I’m doing exactly the same as what I would do with clients face to face and I’m finding no difference of so whatsoever. I’m actually quite surprised by just how well you can form a good trusting relationship with Clients. But I’m actually not doing anything differently. There were obviously some things that I don’t think telehealth would work the best for. But I think for all the things that I am working on with my clients, there are no disadvantages at all that I can see.

Steve: Okay, alright. That’s interesting, and so in relation to that, then let’s talk briefly about some of the advantages to clients of being treated on telehealth. We’ve mentioned a couple already. But if you’d just like to go over what your thoughts on that.

Rhonda: Well I think for some we’re confidentiality or seeing somebody in private is an issue. So let’s say somebody has avoided going to counseling because they don’t want somebody to see them walking to therapist’s office or something like that. And that’s the only reason why they’re avoiding getting help. You don’t have to worry that with telehealth. You can do that form the comfort of your own home. You don’t need to worry about commuting. I’ve had client, most clients have their session while they’re in their own home. But I’ve had clients who holds, I’ve had sessions with where they’re sitting in their car or theure sitting in their car during their lunch break or they’ve gone walking in the park and were talking while they’re in the park. So it opens up things for a client where they can have session where I suits them. As long as the conditions are right, where they don’t impact our ability to see and hear each other. They can hold the session wherever they’re most comfortable which I think is fantastic. I think telehealth at the moment is slightly cheaper than face to face counseling, which I think is really good for the client because more people can access it. What else? What other reasons? And also as I mentioned for some clients who are fearful of meeting people face to face or leaving their home. Now, counseling is available for them without them having to battle or struggle with that, with facing those fears.

Steve: Yes, I mentioned in the intro about the stigma associated with seeking themselves for professional assistance and that is alive and were unfortunately its alive and well. Ans so anything we can do to minimize that for our clients and indeed clients all around the world of all psychology practices is a wonderful thing. Ots such a burden to see our clients sitting in the waiting room sometimes and you can see the heavy hearts and the heavy heads as they are sitting there and waiting for our conditions to see them. And so whatever reduces the stress is what its all about. 

Rhonda: I agree.

Steve: So we there must be, well I shouldn’t say there must be. There are various types of presentations that are better suites to telehealth?

Rhonda: I have found, well certainly the ones where there is an issue with anxiety or social anxiety or anxiety leaving their home. Definitely, its very well suited for those sorts of clients. Also clients who I think probably new to counseling as well because there’s less barriers for them to actually access the counseling. I have had clients who, its their first experience of counseling, they are very nervous to begin with and sometimes they start off with the counseling session just buy phone. I just sort of encourage to just think about it’s a let’s just have a chat and then they kind of relax, So I think for people who have those sorts of struggles, I think telehealth is very good for them. And I think maybe with movies and TV shows that don’t always pain the right picture of what counseling actually look like. For people who are fearful of counseling because of what they’ve seen portrayed in movies or TV, the they can bypass all of that.

Steve: Yes, the modern media. For all of its pluses and minuses has a number of things to answer for in relation to how therapists and therapy sessions are board, trade of course their dramatised. You know the effect of sucking in the reader, the watcher, the listener, the whatever. But you’re right, if you are somebody who has a mental health issue disorder, you’re more deeply affected by what you see on TV than most other people are, I suspect.

Rhonda: Exactly.

Steve: So are there any types of presentations that are not particularly well suited to telehealth?

Rhonda: I don’t think I would offer couples counseling through telehealth because I think it is very important for you to be in the same room with the couple, and to observe their body language m where they choose to sit, how they choose to sit with each other, or in other seats or whatever, and I think you have more control if the situation when you’re in the same room. So I think that is one thing definitely where telehealth probably wouldn’t be my first choice. I would think it would make it harder. Other than that, I don’t practice it but u do wonder and so obviously I’m coming from ignorant perspective, because I’m practising.. I do wonder whether hypnosis works as well through telehealth and that I don’t know. It may work fine but u wonder whether it does. Anything else? I wondered whether if you needed to do exposure therapy with the client. So usually you do. I’m used to doing that while with the client and I wondered whether that would work through telehealth as well. But I have a really good mentor and I raised it with him and he said no works perfectly as long as you have good relationship and you communicate and you and your client communicate well with each other, you can still do exposure therapy with a client really successfully. The client will be your eyes and ears though until you know what they’re going through, what they’re seeing, what they’re sensing. But if you’ve got that down path, its just as effective through telehealth.

Steve: There you go. So this is where my ignorance comes out now, Rhonda. Would you mind just telling me a little bit about because this is going out to a general audience about exposure therapy.

Rhonda: Sure, so exposure therapy is used to treat phobias and anxieties. So lets say ill just use an example. Let’s say you have a phobia against around dogs. So exposure therapy is basically gradually exposing the client to the thing that they’re fearful of, but doing it at their pace. So let’s say they have a fear of dogs. In the therapy room or counseling, we might just talk about dogs and well talk about their level of comfort and their level of anxiety and how they’re feeling. And I will always make sure that the client is comfortable. And then when the client says okay, I’m fine with the chat, let’s go a bit further. And then next session, we might look at photos or pictures of dogs or whatever and we’ve still gauge and check with the client how they’re handling it. Are they getting, is there anxiety building? Can I manage this? Can they sit with this anxiety at the moment that sort of stuff. And you slowly build and build till in the end. The last thing is you actually go out with the client and expose them to real dog. Like maybe just one little dog to begin with, and see how they feel around that, and then maybe a dog. Then eventually having a dog around them till they face that fear and that phobia or fear is no longer a problem for them. 

Steve: Gotcha. Okay, alright, I can certainly see then hos that relates to your potential concerns about it being effective on over telehealth. Yes, its hard to put a dog in the mail and open it up.

Rhonda: (laughs) Yes, that’s right. A bit of animal cruelty there.

Steve: So, we might have to save your clients exposure to my dog who is a very friendly but nonetheless very large great dane. He will lick you, but when he barks, he sounds very serious because he’s got that big chest that it all resonates in right? Okay good. I appreciate the education, thank you very much. So and you mentioned hypnosis there> that’s interesting. I am talking with a gentleman in the upcoming weeks. Hypnotherapy and so ill put your question to him. He’s once again a resident at The Talk Shop. His name is Joseph Szakmary and he’s been doing hypnotherapy for quite some time. So I’m keen to find out what the answer to that question is.

Rhonda: I’m keen to know too, because I think it’s a very effective from of therapy

Steve: So I was having a lunch with Joseph the other day, and we were talking exactly about that. He said it was he’s amased by the results that he gets because of it. And also equally, it comes with conditions like a lot of other therapies, yes seeing praises when done and in the correct surroundings by professional who knows what they’re doing. Its not all about watching the watch.

Rhonda: Yes

Steve: Theres more to it and I’m certain he’s not one of those people who’s in a circus carnival on stage getting them to under hypnosis and dancing like a chicken.

Rhonda: Exactly, that’s the perfect example of what we talked about earlier about how movies or TV shows have missed, misled people thinking it I get hypnosis can they make me cluck like a chicken on stage. 

Steve: I’m wondrous about whether or not one of the reservations people have is the potential loss of control because of things that they have seen in movies. So where are we now? Here we are. So some people may be apprehensive about using this technology for psychological treatment. What sort of advice or comfort do you think you could give them?

Rhonda: Are you talking about people who would be apprehensive about therapy in general or just the process of telehealth?

Steve: Specifically the process of telehealth because not everybody like my wife calls me a lot of time. Im not very good with technology. So fear of getting technology wrong might be something that I would be up against.

Rhonda: Sure, I think for those people perhaps they can start with a phone call to begin with, or perhaps they can arrange for. If they have that fear, I have had a client who struggled with technology as well. So we arranged for somebody on our reception team to contact the client and talk them though it. So that easily done for clients who are new to telehealth. So there are supports for people who do feel that they’re going to struggle with technology. I’m not great with new technology myself. But I found its very easy. You just copy the link, put it into your browser and that’s it, and then it works. It’s so easy. So there’s the, I think most people can do that as long as you can copy and paste, you can use it very easily. I think there are things that you can do to make sure that the telehealth session goes well. Make sure that you’re in a place where you’ve got goo d internet reception. You’ve got a quiet room where nobody’s going to walk in on you or you’re going to be distracted by anything and that’s basically, you really then sit, sorry. And then you sit time aside for the counseling session so you’re not walking around your house as you redoing your housework. It has to be treated like a normal counseling session, so you can focus on the discussion. Rather than being focused on running after your kids at the same time or doing some housework. 

Steve: Sio minimising distractions. I suppose of various shapes and sizes is a key factor of it because of course as you know there’s better than I do of course. But as a psychologist, a large part of the therapy working is maintaining the client’s attention through the whole 50 minutes of the session

Rhonda: That’s right, and also a lot of the big breaks through all the breakthroughs that take place in the counseling session too is when we’re having a chat and the client is thinking about which what we’re chatting about, and there’s a lot of things that they learn just from that. So if they’re distracted, they’re not going to have the opportunity to really think about what we’re talking about.

Steve: Yes, you know more about how the mind works than I do. But if you’re working in associations and links in mental capacity, you want that to be navigable chain. I suppose as opposed to one that’s likely to go off at the wrong exit ramp.

Rhonda: Exactly.

Steve: that could work badly. Have there ever been any studies done about the effectiveness of telehealth?

Rhonda: I took a look to see whether there were any studies on it and there have been quite a few. Generally, what I found it says there’s really no difference in effectiveness between telehealth and face-to-face counseling. They did highlight that it also was very useful for people who have anxieties. Its an easier way for them to access counselling. What else? I can’t remember what else there was, but I think basically there was no difference in the effectiveness of the therapies.

Steve: That’s what I’ve come up with as well. I had a brief look around too. There are multiple studies quoted out there about the effectiveness of telehealth I suppose and in confidence, in a way it works and also that its in the hands of qualified practitioners like yourself who know how to work it to the advantage of their clients.

Rhonda: And with the added convenience and accessibility that it had that it offers for clients, I mean it’s a win-win

Steve: It absolutely is. I can tell you that it’s one of the first things that people who call The Talk Shop are interested whether or not they’re going to be some people still prefer face-to-face and that fine. But some people are very open minded about trying telehealth. Then there’s rarely much in the way of bulking in relation to that. So okay, I’m going to finish with this one now. Rhonda you were formerly in marketing and so I’m going to set you a little project here. If you were to design a marketing campaign for telehealth, what would be the central tenets of that campaign?

Rhonda: I think the benefits, definitely of course. The increased access to support definitely, and from where whatever phase is most suitable for the client that the client’s chosen. The convenience and cost-effectiveness. Increased confident confidentiality that clients can feel accessing this form of counselling. And greater flexibility for both the client and the therapist. So I think in the ad campaign, I’ll make sure I cover some of those.

Steve: That’s excellent. Thank you so much for your contributions today, Rhonda. You’ve been very generous with your time as I know you always are in our interactions and its greatly appreciated. And hopefully, your efforts today will go out today in the big wide world and give people some confidence about telehealth no matter who they go to visit. That’s not what this is about. There’s plenty of reputable practices out there for psychology. But thank you very much for your time today, Rhonda. 

Rhonda: You’re very welcome. Thanks Steve.

Steve: Okay, and everybody, we’ll be back again in about a week or so time with the next instalment of talking shop. Bye for now.